I have at other Times, after a longer Delay, been more successful; the 28th December, the same Year, I was call’d, by Order of the late Lord WEYMOUTH, to the Assistance of a poor Woman at HORNISHAM, whose After-birth had been retain’d three Days; she had contracted a Fever from its Putrefaction, which was so great, that scarcely any Body could bear the Room, and had lost a great deal of Blood by Flooding; the poor Woman soon recover’d after her Delivery, in the Use of a little Medicine, from his Lordship’s House: I have seldom found the Business difficult, when speedily call’d in the like Cases.
CHAPTER X. Difficulties attending the Contraction, or Ill-site of the Inward Orifice.
I
N the Fifth Chapter I have told, how the Midwife may judge, by touching, of an easy Birth; carefully introducing her two Fore-fingers into the Passage, to find the internal Orifice of the Womb in the Beginning of Labour; now, in doing this, if the Orifice, she is in Search for, does not readily occur, she has great Reason to apprehend Difficulty; and if not well acquainted with the Parts she handles, by rude Usage, piercing through any Part of the Vagina, which presents to the Touch, may do Mischief. Such an Injury was done to one of Box, where I was called Sept. 21, 1748. This Woman had been in Labour several Days; the Midwife having, the last Time, been with her eighteen Hours, the Pole of the Child’s Head lay upon the Share-bone, which was rectifyed by one Limb of the Extractor and brought into the Passage; the other Limb being joined, the Infant was soon born; but what before surprized me, was to find a Passage, for my Fingers, considerably remote from the internal Orifice, with great Complaints of a smarting Pain when I touch’d it; a Suppuration follow’d, but the Woman soon recover’d, after the frequent Use of an emollient and discutient Fomentation.
When the Orifice presents rightly, and is easily found, it is next of Consequence to observe, whether the Pains relax, open and enlarge it; for should it remain thick and contracted, instead of relaxing and growing thinner, if the Infant comes rightly directed, the Woman’s Pains are not genuine but spurious; it will then be proper to give an emollient and carminative Glyster, and probably the false Pains will be reliev’d, and the true succeed; or some Time may intervene, before her true Labour, especially if the full Time of Breeding should not be expired.
If the Midwife cannot reach the internal Orifice, and the Child’s Head lays high, the Orifice may possibly lay high, backwards or forwards, or more or less so, inclining Sideways; the Reason of which may be apprehended, from the brief Account of the Womb, and the Pelvis, in the Second Chapter. In this Case it may be with great Difficulty, the Assistant can reach the nearest Margin of the internal Orifice, tho’ well instructed and experienced, and it will often require the Hand of an expert Artist, early in Labour to rectify it, or turn the Child, when Travil is advanced; or if too long neglected may occasion the Death of one, or both Mother and Child.
CHAPTER XI. Difficulties attending a wrong Position of the Child’s Head.
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F in the Progress of Travil, the Midwife perceives any Part of the Head, besides the Crown, discoverable by its Sutures, presenting, and it appear broad, and very hard to the Touch: If the Waters may be felt descending in a long Form through the internal Orifice, somewhat like a Piece of a Gut distended with Water: These Appearances presage the utmost Difficulty and Danger, commonly owing to the small Distance between the forward and back Bones; an ill Situation of the internal Orifice; the comparative Largeness of the Child’s Head; or the ill Site of the Womb; whereby the Head may be pressed against the Bones forward or backward, or somewhat inclined to either Side, in a wrong Direction for the Passage. These Causes, singly or concurring, render the Case much beyond the Skill, and very often the Strength, of a Midwife to redress.
When unqualified Midwives observe the Head present to the inward Orifice, they are too apt to promise good Success, and behave with the utmost Confidence, wherein they are often egregiously mistaken; for there cannot be a more difficult Birth, than frequently happens, when any other Part, instead of the Crown, offers; and the Misfortune is, the longer Recourse to proper Assistance is delay’d, the greater the Difficulty becomes every Moment; and the poor Woman may think herself happy, if she escapes with her Life, the Danger of a most fatiguing and tedious Labour, succeeded, perhaps, by such a Relaxation of the Vagina or Passage, as will occasion great Uneasiness in going, or being in an upright Posture, without the immediate Help of Medicines, both externally and internally; or wearing a Pessary for its Support, during Life.